1. Body Mass Index (BMI) Content Profile Brief Profile Proposal for 2012/13 presented to the Quality, Research & Public Health (QRPH) Planning Committee Jennifer Foltz, MD, MPH, CDC Lori Fourquet, eHealthSign October 26, 2012

2. Quality, Research & Public Health (QRPH) Planning Committee The Problem The current process of Body Mass Index (BMI) information collection – –via current survey methods is inadequate and inefficient: No measured data, no child data at local levels State-level data is not measured height/weight, and not available for children Labor intensive/costly – –Via EHR Transfer is inadequate and inefficient: Representativeness (not many participating: limited data) Involves inconsistent data capture methods Is duplicative: in some cases requiring dual entry by the provider into both the EMR and the reporting tool In some cases involves custom interfaces Inconsistent data quality in data entry and communication Data is underreported and underrepresented These limitations make it very difficult for public health agencies, communities, and jurisdictions to evaluate progress in their childhood obesity rates.

3. Quality, Research & Public Health (QRPH) Planning Committee Value Proposition For the public health, Improve Quality of the Public Health BMI Surveillance SystemFor the public health, Improve Quality of the Public Health BMI Surveillance System –Accuracy of data measured datameasured data –Population representation include measured data for all childreninclude measured data for all children –Timeliness –Granularity down to the local leveldown to the local level For the Providers, Establishing a standard, interoperable approach for BMI data collection willFor the Providers, Establishing a standard, interoperable approach for BMI data collection will –provide a mechanism for quality data collection at a local level with –little burden to providers to provide data –Serve as a foundation for providing feedback to improve the quality of care

4. Quality, Research & Public Health (QRPH) Planning Committee Market Readiness Market ReadinessMarket Readiness – –The use of EHR data as a source for BMI quality data is a requirement for US Meaningful Use stage 1 Core Criteria: Recording of BMI for >50% of patients Menu Set Option for EHR data transfer is improved through menu-set options (e.g. EHR to IIS) – –State interest – –Engaged National stakeholders to work on Other concurrent standardization work with the goal of improving data transfer systems and interoperabiliy (e.g. AAP)

5. Quality, Research & Public Health (QRPH) Planning Committee Existing IHE Profiles and Risks BMI source data and assessments can be expressed in the context of multiple medical summaries.BMI source data and assessments can be expressed in the context of multiple medical summaries. Previous BMI Quality HIMSS demonstration identified inconsistent EMR support for BMI. If there are data requirements not typically managed by the EHR, then this profile may include a content mapping for an RFD-based approachPrevious BMI Quality HIMSS demonstration identified inconsistent EMR support for BMI. If there are data requirements not typically managed by the EHR, then this profile may include a content mapping for an RFD-based approach Risk of this proposal not being undertaken this cycle?Risk of this proposal not being undertaken this cycle? –Lose current interest within the CDC Division of Nutrition, Physical Activity, and Obesity (DNPAO) –Lack of available funding to provide technical resources for profile development in the future –Lack of IHE involvement in proposed pilot projects –Could miss the window of opportunity

6. Quality, Research & Public Health (QRPH) Planning Committee Use Case Current Use Case – –A child presents for a health visit. The child’s weight and height are measured, usually as part of the patient intake. The provider is participating in the jurisdiction’s childhood obesity surveillance system. The provider staff reviews the patient charts on a weekly basis transcribing to paper or to a web data entry system the measured height and weight information available in the EHR. – –The information source and specific workflow for information gathering may vary by provider and as a result, data collected by the surveillance system is inconsistent. Proposed Use Case – –A child presents for a health visit. The clinician documents in the EMR the measured weight and height. The EMR also manages the relevant patient demographics supporting the BMI percentile calculation (e.g. gender, age), and the relevant patient demographics supporting surveillance grouping measures (e.g. zip, ethnicity, race, payer). When the visit is completed, a Summary document is created with BMI Content requirements. This content is provided to the public health surveillance system by way of a transform to the corresponding HL7 BMI message. The BMI content may be optionally coupled with the Immunization reporting methods in support of programmatic workflow and harmonization with Immunization Registry program processes.

7. Quality, Research & Public Health (QRPH) Planning Committee Proposed Standards & Systems HL7 – –BMI HL7 v2.x messaging implementation guide (draft) – –HL7 CDA Release 2.0 HL7/ASTM – –CCD IHE – –IHE PCC Medical Summary – –IHE PCC (XPHR) – –IHE Retrieve Form for Data Capture (RFD) Vocabulary Standards – –LOINC – –UCUM

8. Quality, Research & Public Health (QRPH) Planning Committee Discussion What level of effort do you foresee in developing this profile?What level of effort do you foresee in developing this profile? –Small to Medium level of effort Profile Editor:Profile Editor: –Lori Reed-Fourquet (lfourquet@ehealthsign.com ) e-HealthSign, LLCe-HealthSign, LLC –Jennifer L Foltz, MD, MPH (igc2@cdc.gov) igc2@cdc.gov CDC: Division of Nutrition, Physical Activity, and Obesity (DNPAO)CDC: Division of Nutrition, Physical Activity, and Obesity (DNPAO)